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Cardiovascular Disease Risk in Rheumatoid Arthritis Anno 2022
Bas Dijkshoorn1, Reinder Raadsen1, Michael T Nurmohamed1,2
1Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, Dr. Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
Insights
Rheumatoid arthritis patients face a 1.5x higher risk of cardiovascular diseases (CVD) due to inflammation and traditional risk factors. Mandatory screening is crucial for managing this elevated CVD risk in RA patients.
Area of Science:
- Rheumatology
- Cardiology
- Immunology
Background:
- Patients with rheumatoid arthritis (RA) exhibit a 1.5-fold increased risk of cardiovascular diseases (CVD) compared to the general population.
- Systemic inflammation in RA contributes to atherogenesis, while traditional cardiovascular risk factors like hypertension and dyslipidemia account for approximately 50% of this elevated risk.
Purpose of the Study:
- To highlight the persistent elevated cardiovascular disease risk in rheumatoid arthritis patients.
- To emphasize the importance of screening for cardiovascular risk factors in RA management.
Main Methods:
- Review of current understanding of cardiovascular risk in RA.
- Analysis of the impact of anti-rheumatic medications on cardiovascular risk.
- Assessment of guideline recommendations and clinical practice regarding cardiovascular risk screening in RA.
Main Results:
- Anti-rheumatic medications can partially mitigate CVD risk, primarily by reducing inflammation.
- Despite guidelines recommending screening, it is often poorly implemented in clinical practice.
- RA patients frequently present with undiagnosed and untreated cardiovascular risk factors.
Conclusions:
- Rheumatoid arthritis patients continue to face a significantly higher risk of developing cardiovascular diseases.
- While anti-inflammatory treatments offer some benefit, comprehensive screening for cardiovascular risk factors is essential.
- Mandatory screening is necessary to reduce the cardiovascular risk in RA patients to levels comparable to the general population.
Abstract:
The risk for developing cardiovascular diseases (CVD) in rheumatoid arthritis (RA) patients is 1.5 times higher compared to the general population. This risk is partly due to the contribution of systemic inflammation in increased atherogenesis, while an increased prevalence of "traditional" cardiovascular risk factors, such as hypertension and dyslipidemia, is also attributed to nearly 50% of the total CVD risk. Most anti-rheumatic medication partly reduces this CVD risk, primarily by reducing inflammation. The increased risk is recognized by most guidelines, which advise consequent screening and multiplying calculated risk scores by 1.5. However, screening in daily clinical practice is poorly done, and RA patients often have undiagnosed and untreated risk factors. In conclusion, even nowadays, RA patients still have an increased risk of developing CVD. Advances in anti-inflammatory treatment partly mitigate this risk, but RA patients need mandatory screening for CV risk factors to turn their CVD risk towards that of the general population.
